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To investigate factors predicting hospital mortality and hospital length of stay (LOS) in traumatized adults and older adults, we conducted a three-year retrospective study at an academic hospital, Bangkok, Thailand. We reviewed medical records of 627 trauma patients admitted to the ED. Subjects were classified into 2 groups: adults (□55y), and older adults (□55y). Data were collected for demographic and clinical characteristics, physiologic deterioration using the Modified Early Warning Score (MEWS), severity of injury using the Circulation Respiration Abdomen Motor and Speech Score (CRAMS), and outcomes of hospital mortality and LOS. Multivariable logistic and linear regression models were performed. For hospital mortality, an elevated MEWS (Older adults [n= 267]: MEWS≥3, OR=4.80, 95%CI, 1.02-22.56 vs Adults [n = 360]: MEWS≥4, OR=11.63, 95%CI, 1.94-69.82) and CRAMS (Older adults: CRAMS≤9, OR=19.21, 95%CI, 2.78-132.98 vs Adults: CRAMS≤6, OR=18.58, 95%CI, 3.40-101.65) were strongly predictive, adjusted for demographic and clinical data. For LOS, road traffic accident (RTA) (Older adults: β=0.80, 95%CI, 0.31-1.29, p < .01 vs Adults: β=0.44, 95%CI, 0.21-0.67, p < .001) and falls (Older adults: β=0.88, 95%CI, 0.44-1.32, p < .001 vs Adults: β=0.33, 95%CI, 0.02-0.65, p < .05) were associated with LOS, adjusted for demographic and clinical data. MEWS and CRAMS predicted hospital mortality, and RTA and falls predicted LOS in both age groups. Results support the need for interventions for close monitoring and medical management for older traumatized patients based on CRAMS and MEWS assessment to decrease the risk of death, and targeting those sustaining falls and RTA to reduce prolonged LOS.

Almost half of older adults experience multisite musculoskeletal pain (MMP) contributing to difficulty in daily activities but little is known about specific domains by which pain interferes in daily living. This study aims to determine domains of pain interference (PI) related to MMP in a cohort of older adults living in the community. The MOBILIZE Boston Study (MBS) is a cohort study of 749 adults aged ≥70y. Musculoskeletal (MSK) pain was assessed using the joint pain questionnaire and grouped as: no pain, single site, and multisite pain. The Brief Pain Inventory PI sub-scale assessed level of interference (0-10 rating) in 7 categories in the previous week including general activity, mood, walking, work, relationships with people, sleep, and enjoyment of life. Interference items were grouped as: none (0 rating), mild (>0, ≤2), moderate ( ≥2, ≤5), and severe (≥5) PI. There was a strong gradient of PI according to pain groups with severe walking interference in 36.5% of those with MMP compared to 3.8% of those with no MSK pain. The least PI was in relationships with others (9.1% of MMP vs 1.1% of no MSK pain). Reports of interference in other domains were intermediate (20-26% of MMP vs 3-4% of no MSK pain). Women and those with Less education reported the most PI in every domain but no differences were observed by age. Greater attention to specific domains of pain interference such as walking could have substantial benefits for reducing the overall impact of MMP among older adults.

This study examined the feasibility and acceptability of an exergaming program that utilized custom exergames, and compared it to a traditional physical exercise (control) program in older adults at risk for falls. A quasi-experimental study was conducted in older adults who lived in senior living communities. Participants enrolled in either program offered twice weekly for 8 weeks based on their residential site. Thirty-five participants enrolled in the study (mean age 77±7y) and 29 (82%) completed the follow-up assessment (exergaming: 93%; control: 73%). Overall attendance was 73% (exergaming: 79%; control: 68%), and 22 participants returned their program satisfaction form. There were no significant between-group differences in ratings of overall quality, enjoyment, instructors, peers, and facility of their assigned exercise programs. The exergaming intervention was well received and perceived as enjoyable. This study demonstrates that an 8-week exergaming intervention is feasible and acceptable for older adults at risk for falls.

Fall injuries are a leading cause of death among older adults, and chronic pain has been identified as a fall risk factor. However, the potential impact of chronic pain on injurious falls is unknown. This prospective study examined the relation between chronic pain and injurious falls in a 4-year follow-up of community-dwelling older adults. The MOBILIZE Boston study recruited 765 older adults aged ≥70y living in the Boston area. Pain characteristics, including pain severity, pain interference, and pain location, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Musculoskeletal pain distribution was categorized as “no pain”, “single site pain”, or “multisite pain”. Injurious falls were ascertained in telephone interviews following reports of falls on the monthly fall calendar postcards. The overall rate of injurious falls was 35/100 person-years. Negative binomial models, adjusting for sociodemographics, BMI, chronic conditions, mobility difficulty, analgesic and psychiatric medications, and depression, showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls. Participants in the highest third of pain interference scores had a 53% greater risk of injurious falls compared to those in the lowest pain interference group (adj.IRR=1.53, 95% CI: 1.15, 2.05). Older adults with multisite pain had a 50% higher risk of injurious falls than those without pain (adj.IRR=1.50, 95% CI: 1.16, 1.93). Risk of injurious falls related to pain was stronger among women than men. Research is needed to determine effective strategies to prevent fall injuries among older adults with chronic pain.

Both chronic pain and fear of falling can lead to activity restriction and increased fall risk among vulnerable elders. Little is known about pain characteristics that may be associated with fear of falling, contributing to restricted activity. We studied 765 adults aged ≥65y (mean=78.9y) in the MOBILIZE Boston Study, to evaluate the cross-sectional relationship between pain characteristics and fear of falling measured using the Falls Efficacy Scale (FES). In addition, we examined the impact of pain and fear of falling on restricted activity. We measured 3 domains of global pain: pain distribution (none, single site or multisite pain), and Brief Pain Inventory subscales of pain severity and pain interference. Restricted activity days (RADs) refer to the count of self-reported days of reduced activity due to illness or injury in the previous 12 months. We performed multivariable logistic regressions predicting fear of falling (FES

Chronic musculoskeletal pain is linked to increased fall risk among elders. Older adults with chronic pain also experience mobility limitations. This prospective study examined the mediating effect of gait measures in the relationship whereby pain leads to falls. In the MOBILIZE Boston Study II of adults aged ≥70y living in the Boston area, 294 completed the gait assessment. Chronic musculoskeletal pain was classified as multisite, single site, or no pain, based on pain assessment of the hand/wrists, shoulders, back, hip, knees and feet. The gait assessment included walking under each of 3 conditions, quiet walk (QW), easy dual task (DTE), and hard dual task (DTH), on a 16-foot sensored gait mat. Participants were instructed to subtract aloud from 100 by 5’s (DTE) and 3’s (DTH) while walking at a normal pace. Following baseline assessments of pain and gait, monthly fall calendars were collected over 2 years. Multivariable negative binomial models were performed to determine associations between pain and fall rates, adjusting for sociodemographic and health characteristics. Mediation effects of gait measures on the pain-fall relationship were evaluated using the Sobel test. Multisite pain was associated with a 51% increased risk of falls compared to no pain (adj. IRR=1.51, 95% CI: 1.51–2.10). A number of gait parameters mediated (p-value

Prevention of falls is a public health priority around the world. A key component in preventing falls is identification of factors that increase the risk of falls. Pain is a highly prevalent risk factor for falls and the role of cognition offers new avenues for investigation. Our symposium provides an epidemiologic perspective on the characteristics of pain and cognition and their role in the relation between pain and risk for falls. Dr. Manu Thakral will present a MOBILIZE Boston (MBS) I study on the relation between pain quality and risk for falls. Her work shows that those reporting cognitive/affective descriptors, i.e. miserable and unbearable, were at higher risk for falling than other descriptors. Dr. Suzanne Leveille will discuss persistent multi-site pain as a fall risk factor from the MBS II study. Her findings showed that attention mediated the pain-falls relationship in multi-site pain including measures of selective attention, visual attention and attentional switching. Dr. Kushang Patel will present longitudinal data from the National Health and Aging Trends Study on the risk of recurrent falls among elders with and without pain and dementia. His work showed that the risk for recurrent falls was almost 3 times higher for elders with pain and dementia compared to those without. Dr. Elizabeth Phelan will serve to discuss our findings in context of the state of the science on fall risk factors. Our findings have substantive implications for future pain management and fall prevention interventions which should consider cognitive factors in the experience of pain.

The relation between pain quality and fall risk is understudied. Understanding the role of pain quality in fall risk could inform tailored fall prevention interventions. A population-based sample of 560 elders in MOBILIZE Boston Study I selected pain qualities to describe how their pain may feel from 3 categories: cognitive/affective, sensory and neuropathic. Participants recorded falls on monthly calendars over 18 months. Rate ratios and 95% confidence intervals were estimated from negative binomial models predicting fall rate and adjusted for fall risk factors. Individuals reporting cognitive/affective descriptors had a 35% increased risk for falls (adj RR 1.35, 95% CI 1.01–1.79) similar to neuropathic descriptors. No statistically significant increased risk was associated with sensory descriptors. Individuals reporting 3 categories had a 47% increased risk for falls relative to 1 category (adj RR 1.47, 95% CI 1.04–2.06). Further study could elucidate whether pain management tailored for pain quality can reduce fall risk.

Chronic musculoskeletal pain (CMP) contributes to increased fall risk among older adults. Fall often occurs due to loss of standing balance. Standing postural control is “complex”, depending upon numerous inputs interacting across multiple temporal-spatial scales. The decreased complexity has been linked to increased fall risk. Pain may interfere with this metric of postural control, thus, lead to falls. The aim of this study is to determine whether CMP is associated with sway complexity in older adults. In the MOBILIZE Boston Study, 738 community-dwelling adults aged ≥70y completed a functional assessment, including eyes-open standing postural sway on a force plate. The degree of sway complexity was quantified using multiscale entropy. The Brief Pain Inventory and McGill Pain Map assessed global pain severity and pain locations, respectively. Relationships between pain and sway complexity were analyzed using multivariable Generalized Linear Models. More severe pain was significantly associated with peripheral neuropathy, impaired processing speed (Trail Making A (TMT-A)) and global cognitive function (Mini-Mental State Examination (MMSE). Those with moderate-to-severe pain had lower complexity compared to those with mild or no pain (p=0.01), adjusted for age, gender, education, neuropathy, and TMT-A or MMSE. Participants with lower leg pain had lower sway complexity than those without (p=0.01); no association between pain in other body sites and sway complexity were observed. CMP severity and lower leg pain are associated with decreased sway complexity in older adults. Future studies are needed to explore the underlying mechanisms through which the CMP affects sway complexity, thus, contributes to falls.

One in five elders in the U.S. are edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g. diabetes) have been identified as possible risk factors for edentulism, data on multiple chronic conditions in relation to tooth loss is lacking. This study examined the association between major chronic conditions and tooth loss in the older US population. We performed a secondary data analysis 2012 Behavioral Risk Factor Surveillance System survey restricted to persons aged ≥65y. Tooth loss was categorized into four groups (no loss, lost 1–5 teeth, lost ≥6 teeth, and edentulous). Descriptive analysis and multinomial logistic regression were used. Sample weights were applied to derive population estimates. Among the 112,376 respondents, average age was 74y and 60% were women. We found that 27% reported no tooth loss and 15% were edentulous. Adjusted for sociodemographics and behavioral characteristics, chronic diseases associated with edentulism were: COPD (RR 1.95, 95%CI 1.68–2.26); cardiovascular disease (RR 1.44, 95%CI 1.26–1.64); arthritis (RR 1.31 95%CI 1.19–1.44); diabetes (RR1.14, 95%CI 1.02–1.28); and kidney disease (RR1.21, 95%CI 1.00–1.45). Cancer, stroke and asthma were not associated with edentulism. Also, older adults with two or more chronic diseases were more likely to have tooth loss (lost 1–5 teeth: OR1.12, 95%CI 1.04–1.19; lost≥6 teeth: OR 1.51, 95%CI 1.40–1.63); Edentulous: OR 1.54, 95%CI 1.40–1.68). Further research is needed to understand the relationship between chronic conditions and tooth loss in older adults. Interventions are needed to improve oral care and reduce risk for tooth loss.

Cognitively stimulating activities can improve both cognitive and physical function. Foot reaction time, a test of neuromotor performance and a possible risk factor for falls in older adults, might be influenced by participation in cognitively stimulating activities. The aim of this cross-sectional study was to examine the association between cognitive leisure activities and foot reaction time. We studied 310 community-dwelling older adults aged 71 to 101 years (mean=84.0y), in the MOBILIZE Boston Study II. Simple foot reaction time (SRT) and choice foot reaction time (CRT) were measured as time to initiation of movement in response to an intermittent light stimulus, seated with feet placed on a gait mat (CIR Systems, Inc., Franklin, NJ). The Cognitive Activity Scale (CAS), assessed frequency of participation in 17 cognitive leisure activities. SRT and CRT ranged from 0.17 to 0.55ms (mean=0.25 ± 0.06ms), and 0.21 to 0.72ms (mean=0.32 ± 0.08ms), respectively. Average SRT and CRT were shorter according to higher CAS scores. In multivariable models adjusted for age, sex, race, education, mobility difficulty, peripheral arterial disease, and number of joint pain sites, CAS scores were associated with shorter SRT (p=0.02) and CRT (p=0.01). The association persisted but was weaker after further adjusting for gait speed (SRT, p=0.05; CRT, p=0.03). Adjustment for vision impairment did not alter the relationship between CAS and reaction time. These results show that participation in cognitively stimulating activities is associated with shorter foot reaction time. Further research is needed to determine whether participation in cognitive activities could reduce fall risk in older adults.

The identification of novel targets that are risk factors for mobility limitations may improve the ability to prevent and treat mobility impairments among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults. We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged ≥ 67 years who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios for mobility limitations at 1-year follow up as a function of coordination variability and asymmetry. Adjusting for age, sex, body mass index, Mini Mental-State Examination score, and number of chronic conditions, odds ratios were significant for developing mobility limitations associated with a 1 standard deviation difference in the variability of ankle (OR = 1.88; 95% CI: 1.16–3.05; P = 0.011) and shoulder (OR = 1.96; 95% CI: 1.18–3.26; P = 0.009) coordination. Odds ratios were significant for asymmetry of shoulder (OR = 2.08; 95% CI: 1.23–3.51; P = 0.006), but not ankle (OR = 0.96; 95% CI: 0.60–1.55; P = 0.870) coordination. The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. These findings indicate that the treatment of impaired coordination may be a means for preventing mobility limitations among older adults.